Regulator sues health insurer Medibank

Australia

09/05/2019

Competition Policy International

Australia’s consumer watchdog announced on Tuesday, September 3, it had sued Medibank Private alleging the health insurer had denied benefits to hundreds of customers who were entitled to payouts, reported Reuters.

About 800 holders of “lite” or “boost” policies of Medibank’s low-cost AHM brand were incorrectly told they were not entitled to be covered for joint investigations or reconstruction procedures when in fact they were paying for such coverage, the Australian Competition and Consumer Commission (ACCC) alleges in the case before the Federal Court.

“Some members were forced to delay surgery due to high out-of-pocket costs for these procedures and to seek alternative remedies to manage pain, when they were in fact entitled to insurance cover,” ACCC Chair Rod Sims said in a statement.

“Medibank’s alleged misrepresentations had serious consequences for members requiring procedures including spinal surgery, pelvic surgery, hip surgery and knee reconstructions, which often cost thousands of dollars.”